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Generate impression based on findings. | Left tonsillar mass. There is an infiltrative mass that involves the left tongue base and palatine tonsil with extension into the soft palate, oral tongue, and across the midline. There also appears to be extension towards the supraglottic larynx, with effacement of the pre-epiglottic fat. Overall, the mass measures up to approximately 45 mm. The pterygoid muscles appear to be sparred. There is a conglomerate of left level 2 and 3 lymph nodes that measures up to approximately 60 mm collectively. The lymph nodes are partially necrotic and the margins of the lymph nodes are ill-defined and partially inseparable from the adjacent sternocleidomastoid muscle, which is suggestive of extracapsular extension. There is also a necrotic left posterior level 3 lymph node that measures up to 22 mm. Right level 2 lymph nodes are not significantly enlarged by size criteria, but display prominent contours. The thyroid and major salivary glands are unremarkable. There is compression of the left internal jugular vein by the adjacent lymphadenopathy. The other major cervical vessels are patent. There is multilevel degenerative cervical spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. An infiltrative mass that measures up to 45 mm compatible with squamous cell carcinoma involves the left tongue base and palatine tonsil with extension into the soft palate, oral tongue, and across the midline, as well as extension towards the supraglottic larynx, with effacement of the pre-epiglottic fat. 2. Extensive left cervical lymphadenopathy compatible with metastatic disease.3. Right level 2 lymph nodes are not significantly enlarged by size criteria, but display prominent contours, which is nonspecific. |
Generate impression based on findings. | There is an unchanged extensive area of hypoattenuation in the right cerebral hemisphere and encephalomalacia involving the periventricular white matter, the right parietal lobe, insula and temporal lobe, consistent with chronic infarct. There is ex vacuo dilatation of the right lateral ventricle, but the ventricular system is otherwise unremarkable. There are mild patchy white matter hypoattenuation in the left hemisphere, which is nonspecific, but compatible with age indeterminate small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull is unremarkable. There is mild focal scalp thickening of the bilateral frontal regions, which may represent redundant skin. | 1. No acute intracranial hemorrhage or mass. 2. Extensive chronic right-sided infarct in the MCA distribution. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern and there is no contraindication to MRI, MRI of the brain is recommended. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of benign left stereotactic biopsy and prior left cyst aspiration. Two standard digital views with an additional left MLO view of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Biopsy marker clip is identified in the left upper outer breast. Benign intramammary lymph node is identified in the right outer breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. Physical examination is of increased importance for patients with dense breasts. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications, including arterial calcifications, are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Baseline exam for pre-heart transplant evaluation LIVER: The liver measures 14.8 cm in length. No masses. Portal vein is patent with flow towards the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 12.6 cm in length. No focal abnormalities identifiedKIDNEYS: No hydronephrosis of either kidney. The right kidney measures 11.3cm in length and the left kidney measures 11.6 cm in length. ABDOMINAL AORTA: No significant abnormality noted. No evidence of aneurysm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. | Normal appearing abdominal ultrasound examination. |
Generate impression based on findings. | 66-year-old male with history of tachycardia and hypoxia. Evaluate for PE. Additional history given per service, patient with known invasive capillary thyroid carcinoma and recent radical resection with tracheostomy. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: Multiple bilateral areas of pleural thickening with calcific plaque formation. Mild dependent atelectasis, and scattered linear opacities that could be atelectasis or scarring. Minimal bronchiectasis at the bases, with additional foci of predominantly ground glass opacities bilaterally, could be due to recurrent aspiration. Underlying fibrosis is likely, which may also be related to asbestos exposure.MEDIASTINUM AND HILA: Tracheostomy tube tip approximately 3 cm above the carina. Nasogastric tube tip within the stomach. Right neck surgical drain and surgical clips, with foci of soft tissue gas in the thyroid bed consistent with given history of recent neck dissection.CHEST WALL: Multilevel bridging anterior osteophytes and ossification of the anterior longitudinal ligament. Degenerative disease affects the bilateral shoulders, sternum and spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No pulmonary embolus.2.Multiple foci of pleural thickening and calcific plaque formation, likely related to prior asbestos exposure.3.Predominantly dependent mild scarring/bronchiectasis and scattered ground glass opacities, may represent the sequela of aspiration.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male 42 years old; Reason: gastric cancer - rescan after txt completion History: gastric cancer CHEST:LUNGS AND PLEURA: Previously described 6-mm nodule in the left lung measures 5-mm (series 5, image 52) and demonstrates ground glass attenuation. A 3mm nodule in the right middle lobe is also less conspicuous on today's study (series 5, image 58). MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right-sided Port-A-Cath with tip in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions throughout the liver consistent metastases. Multiple hepatic metastases are stable/mildly decreased. The reference left hepatic metastasis measures 2.2 x 2.2 cm (series 3, image 94), previously 2.2 x 2.1 cm. The reference inferior right hepatic lobe metastasis measures 3.0 x 2.8 cm (series 3, image 123), previously 3.9 x 2.4 cm.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic duct dilatation is unchanged compared to recent studies, presumed secondary to mass effect/invasion from gastric mass. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Persistent severe left-sided hydronephrosis and reduced perfusion of the left renal cortex consistent with obstruction with abnormal caliber change in the mid ureter. No definite mass is identified. This is not significantly changed compared to prior study.RETROPERITONEUM, LYMPH NODES: Reference right periaortic node measures 1.0 x 0.9 cm (series 3, image 115) previously 1.7 x 1.1 cm.BOWEL, MESENTERY: Gastric wall thickening is unchanged compared to prior study.BONES, SOFT TISSUES: Diffuse sclerotic metastatic disease throughout the osseous skeleton. Preservation of vertebral body height.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse sclerotic metastatic disease throughout the osseous skeleton. Preservation of vertebral body height.OTHER: No significant abnormality noted | 1.Decrease in size of subcentimeter pulmonary nodules.2.Stable/mild decrease in size of multiple hepatic metastases.3.Mild decrease in reference periaortic lymph node. 4.Stable gastric thickening.5.Stable left hydronephrosis and proximal hydroureter.6.Stable diffuse sclerotic metastases. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications are present in the right breast. Stable focal asymmetry in the right outer breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 64-year-old male history of cerebral infarction. Please note that this study was submitted for independent interpretation and was performed at Roseland Community Hospital. There is no evidence of acute intracranial hemorrhage. There is a small chronic infarct within the right occipital lobe. Mild periventricular and subcortical white matter hypoattenuation compatible with age indeterminate ischemic small vessel disease. There is no evidence of midline shift or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. There are symmetric lucencies in bilateral occipital bones which likely represent vascular channels. | 1.Chronic infarct within the right occipital lobe.2.Mild age indeterminate ischemic small vessel disease. |
Generate impression based on findings. | Metastatic thyroid cancer evaluate for treatment. CHEST:LUNGS AND PLEURA: Diffuse pulmonary metastases, some of which appear larger. Left upper lobe lesion measures 15 mm, unchanged (6/24).Second left upper lobe nodule 13 x 14 mm, previously 12 x 13 mm (6/27).Right upper lobe nodule 12 x 12 mm (6/27), previously 11 x 11 mm.Partial clearing of suspected inflammatory or infectious lesions in the right upper lobe (6/21).MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Subcentimeter lucency in the T12 vertebral body (41/91).Right low cervical venous encasements appears unchanged, please refer to separately reported neck CT.Mild mediastinal and moderate right hilar lymphadenopathy about the same. Right hilar lymphadenopathy causes mild extrinsic compression of the bronchus intermedius laterally.Moderate coronary artery calcifications.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Partially calcified lesion in the right lower quadrant mesentery adherent to a bowel loop (series 41, image 130) not significantly changed in size, with adjacent mild desmoplastic reaction. In retrospect, this was difficult to visualize but present on all the patient's prior studies dating back to 2007, similar to recent studies but slightly increased from exams of 2012.BONES, SOFT TISSUES: Small area of sclerosis in the right ilium near the SI joint (series 41, image 159). Punctate lucencies in the right iliac wing along with a larger lytic lesion causing cortical disruption (image 148). Faint lucency in the left posterior aspect of the L1 vertebral body as well and diffusely in L3 and L4.OTHER: No significant abnormality noted. | 1. Diffuse pulmonary metastases with no significant change in size of reference lesion measurements.2. Stable mild mediastinal and moderate right hilar lymphadenopathy.3. Skeletal metastases are extremely subtle and difficult to visualize however cortical break through in the right iliac wing lesion appears new since prior exam.4. Partially calcified soft tissue nodule adherent to bowel within the mesentery not significantly changed. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There minimal scattered areas of abnormal low density in the periventricular and subcortical white matter, consistent with mild age-indeterminate small vessel ischemic changes. There is a small focus of ill-defined abnormal low density in the left superior frontal gyrus left paramedian cortex and underlying cortical white matter, better seen on the thin section images. There is no significant focal volume loss. A punctate calcification is incidentally noted at the same level within the right lateral frontal subarachnoid space. A few scattered parenchymal calcifications are also noted. There is no extraaxial fluid collection. There is mild mucosal thickening in the left frontal ethmoidal recess. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Prominent intracranial vascular calcifications are present. | No acute intracranial hemorrhage. Mild age-indeterminate small vessel ischemic changes, including a more focal area in the left superior frontal gyrus with cortical involvement and no significant focal volume loss, possibly representing more acute ischemia. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended. |
Generate impression based on findings. | 57-year-old female for lung transplant evaluation Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 62 % of peak activity (normal >70 %)1 hour: 52 % of peak activity (normal 30-90 %) 2 hours: 17 % of peak activity (normal <60 %) 4 hours: 2 % of peak activity (normal <10 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | 33-year-old male with history of ventricular peritoneal shunt for Dandy-Walker cyst. There is no evidence of acute intracranial hemorrhage. A right frontal approach ventricular catheter is present with tip in the expected location of the foramen of Monro. There is stable supratentorial ventriculomegaly measuring 6.8 cm (image 19 series 80224). The cerebellar vermis and hemispheres are atrophic. The corpus callosum is severely thinned. There is patchy white matter hypoattenuation within bilateral atrophic frontal lobes appearing similar to prior. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. | 1.Stable right frontal approach ventricular shunt catheter.2.Ventriculomegaly without significant interval change.3.Other abnormal findings are stable. |
Generate impression based on findings. | 68 year old female with history of COPD, sleep apnea, hepatitis C, presenting with shortness of breath and new lung nodules. Evaluate for malignancy. LUNGS AND PLEURA: Left upper lobe spiculated solid nodule (5/21) measuring 18 x 15 mm. Minimal subsegmental basilar atelectasis. Mild apical predominant emphysema. No additional suspicious nodules or masses. No pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits, no significant pericardial effusion. Mild coronary artery calcifications. Scattered small lymph nodes are seen within the mediastinum, including a small AP window lymph node (3/31) measuring 10 mm in the short axis.CHEST WALL: Minimal degenerative changes affect the visualized spine, with anterior osteophytes and endplate sclerosis.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Left upper lobe spiculated solid nodule, which is suspicious for a pulmonary malignancy.2.Several small mediastinal lymph nodes as above.3.No additional evidence of metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in paternal cousin. Two standard digital views with additional left MLO view of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications, including arterial calcifications, are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Coarse benign calcifications are identified in the left breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male, 43 years old, with syncope and head trauma, subarachnoid hemorrhage seen on prior head CTs. No intracranial hemorrhage is seen. No evidence of parenchymal edema or mass effect is detected. Gray-white differentiation is preserved. The ventricles are stable and normal in size.Opacification of the left maxillary sinus is unchanged. The osseous structures of the skull are intact. Mild subgaleal thickening along the right parietal bone persists. | No significant changes and in particular no evidence of intracranial hemorrhage. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with an additional left MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Coarse benign calcifications continue to progress in a benign fashion bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 83-year-old male with history of metastatic prostate cancer. Tobacco abuse. Concern for left upper lobe mass on chest radiograph. LUNGS AND PLEURA: Scattered, nonspecific pulmonary micronodules. No left upper lobe mass or consolidation to correspond with the chest radiograph. Mild upper lobe predominant emphysema. Mild dependent scarring/atelectasis. Unspecified interstitial fibrosis periperally. No consolidation or pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits, no pericardial effusion. Severe coronary artery calcifications.Severe atherosclerotic calcifications of the aorta and its branches. No mediastinal or hilar lymphadenopathy. There is a slightly greater than expected amount of mediastinal fat deposition, which may account for the chest radiograph findings. Left chest AICD with leads in the expected location. CHEST WALL: C2 through C5, and T3 vertebral body sclerosis, may represent sclerosis from metastatic prostate cancer.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerosis affects the aorta and its branches. Small hila hernia. | 1.No left upper lobe mass or consolidation to correspond with chest radiograph findings, however increased mediastinal fat deposition and overlying heterotopic bone may account for the previously seen opacity.2.Scattered nonspecific pulmonary micronodules, with mild emphysema and dependent scarring. Given this patient's high risk status for lung cancer, yearly low dose screening CT chest without contrast is recommended.3. Sclerosis of several vertebral bodies, likely related to patient's history of metastatic prostate cancer. |
Generate impression based on findings. | 59-year-old male on hormone therapy for breast growth who presents for baseline examination. No current breast complaints. Three standard views of both breasts and two left spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Focal asymmetry in the left inner lower breast disperses into normal breast parenchyma on the additional spot compression views.No suspicious masses, microcalcifications or areas of architectural distortion are present in either breast. | No mammographic evidence of malignancy. Follow up to be directed by the clinical service. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 64-year-old male with history of prostate cancer. Evaluate for rib lesions. LUNGS AND PLEURA: Mild apical predominant emphysema. No consolidation or pleural effusion. Scattered micronodules, nonspecific. No suspicious nodules or masses.MEDIASTINUM AND HILA: Heart size within normal limits. No pericardial effusion. Mild coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative changes affect the joint spine, including endplate sclerosis and likely early Schmorl's nodes. Subtle focal sclerosis of the left seventh rib anteriorly, may represent a metastatic deposit versus normal variant, with no visible abnormality of the left eighth rib. No additional sclerotic foci to suggest metastatic disease.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Subtle focal sclerosis of the left seventh rib anteriorly, without abnormality of the left eighth rib. Nonspecific, but could conceivably represent metastatic prostate cancer. No additional findings to suggest metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in sister. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Female; 42 years old. Reason: View of joint space, concern for inflammation vs. benign cyst History: 2nd finger MCP joint swelling and pain The bones and joints appear normal. No acute fracture or malalignment is evident. No erosions or other specific findings to suggest inflammatory arthritis. | Normal appearance of the bones.Findings were text paged to pager 3050 at 10 a.m. on 1/9/15. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Cystic fibrosis lung transplant workup. LUNGS AND PLEURA: Postsurgical changes of right lower lobectomy. Asymmetric lung volumes, left greater than right. Moderate diffuse bronchiectasis, endobronchial fluid and debris in a pattern consistent with cystic fibrosis. Within the anterior the lingula, there is a small area of consolidation. In the right lateral costophrenic angle, bronchiolitis and distal atelectasis noted diffusely.Paraseptal emphysema at the lung apices, right greater than left. Paucity of lung markings in the right middle lobe near the diaphragm consistent with emphysema. Trace pleural fluid and thickening on the right.MEDIASTINUM AND HILA: Nonspecific cysts/nodules in the thyroid gland bilaterally. Rightward mediastinal deviation. Small mediastinal and hilar lymph nodes bilaterally. Normal heart size. No pericardial fluid. Postsurgical changes in right lower lobectomy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. The pancreas is not visualized within the scanning range and cannot be assessed. Staghorn calculus in the upper pole of the right kidney measuring up to 2.2 by 1.5-cm. Subcentimeter lucency in the left kidney too small to accurately characterize but probably a cyst. | 1. Severe bronchiectasis with endobronchial fluid and debris in a pattern consistent with cystic fibrosis. Unable to exclude postobstructive pneumonia in the anterior lingula. Bronchiolitis in the right middle lobe near the costophrenic angle laterally may be postobstructive or infectious. 2. Postsurgical changes of right lower lobectomy with moderate to severe emphysema in the remaining right middle lobe.3. Staghorn calculus upper pole right kidney. No hydronephrosis within the partially visualized kidney.4. Nonspecific lesions in the thyroid gland. |
Generate impression based on findings. | Male 73 years old; Reason: concern for drive line infection History: pain, vad LVAD device projects over the left upper abdomen. Postsurgical changes with clips in the right upper abdomen. Additional controller device projects over the pelvis.Bowel gas pattern is nonobstructive. Mild gaseous distention of the small bowel and colon suggests an ileus. Severe degenerative changes affect the lumbar spine. | 1.Small bowel ileus. |
Generate impression based on findings. | The colon is mildly distended apart from the proximal sigmoid colon on the supine view, but mostly collapsed on the prone and decubitus views. Residual fluid throughout the colon is well tagged with oral contrast. The sigmoid colon is markedly tortuous. No polyps > 10 mm or colonic masses are identified. There is abnormal thickening of 4.7 cm of terminal ileum.Note: CT colonography is not intended for the detection of diminutive colonic polyps (i.e., tiny polyps < 5 mm), the presence or absence of which will not change management of the patient.EXTRACOLONIC | No polyps > 10 mm or colonic masses are identified, but given the patient risk factors, I recommend repeat attempt to optimize prone and if necessary decubitus view distension to rule out 6 mm polyps and evaluate the collapsed sigmoid colon. This was discussed with the patient and scheduled.Nonspecific terminal ileum thickening. Long segment is atypical for neoplasm (but can't be excluded unless there is long term stability) or inactive inflammatory bowel disease (for which there are no other stigmata).Diffuse hepatic steatosis. Right adrenal nodule which does not meet criteria for lipid rich adenoma. Further characterization with adrenal protocol CT/MRI may be obtained for further characterization if there is concern for non-adenomatous lesions, but given no underlying diease, adenoma is still statistically the most likely diagnosis.*OPTIONAL C-RADS CLASSIFICATION:C-1 (with poor confidence)E-3*(see full definitions in: Zalis et al. CT Colonography reporting and data system: a consensus proposal. Radiology 2005;236:3-9)C1: Normal or benign lesions (no polyps > 6mm). Continue routine screening.C2: Intermediate polyp (less than three 6-9mm polyps or can't exclude >6mm in technically adequate study. Surveillance CTC or colonoscopy recommended.C3: Polyp, possibly advanced adenoma. (polyp >10mm or >three 6-9mm). Colonoscopy recommended.C4: Colonic mass, likely malignant. |
Generate impression based on findings. | 52-year-old female with history of left breast cancer who presents for ultrasound guided needle localization prior to surgery. On review of the prior studies, there is a left breast hypoechoic mass at approximately 6 o'clock position. No clip was placed during the outside hospital biopsy and the lesion is mammographically occult, so it was determined that the best way to localize the lesion was to target the mass on ultrasound. Target well defined mass morphology are located in the left breast in the lower outer quadrant region located in mid-breast 6:00 position. The degree of biopsy change and hematoma appear decreased compared to the prior ultrasound.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast cleaned with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using sonographic guidance, a 5 cm Kopans needle was placed through the lesion. On ultrasound, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Multiple view orthogonal mammograms could not well visualize the re-enforced portion of the wire due to it's posterior position. The mammogram was annotated prior to the patient's procedure. Patient tolerated the procedure well and was sent to nuclear medicine in stable condition. Dr. Schacht performed the procedure and was present during the procedure at all times.Specimen ultrasound is planned and will be separately dictated. | Successful needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 10-year-old male. Distal tibia fracture. Evaluate fracture healing.VIEWS: Right ankle AP/oblique/lateral views (3 views) 1/9/2015. Healing distal tibial fracture in anatomic alignment. | Healing distal tibial fracture. |
Generate impression based on findings. | Biopsy-proven left breast cancer on neoadjuvant Femara. Assess response to treatment. BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round markers were placed on skin lesions overlying both breasts. Focal asymmetry is present at the 3 o'clock position of the left breast although a discrete mass is no longer seen at this site. Stable calcifications are present in the region of the focal asymmetry. Arterial calcifications are present. Benign morphology lymph nodes project over the left axilla.No new masses are present in either breast. LEFT BREAST ULTRASOUND: On physical examination, palpable fullness is present in the left lateral breast. A targeted left breast ultrasound was performed at the site of patient's known cancer. Near the two o'clock position of the left breast, 3 cm from the nipple, several hypoechoic lesions are present, measuring in aggregate 2.6 x 0.7 x 0.8 cm. On the most recent prior ultrasound, the largest mass measured approximately 2.2 x 0.9 x 1.1 cm. Images of the left axilla demonstrate two axillary lymph nodes measuring 8 mm and 6 mm in bipolar diameter. Both of these lymph nodes are smaller than on the prior study and now have fatty hila. | Interval decrease in size of multifocal left breast cancer and left axillary lymph nodes. Results were discussed with the patient and her daughter.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Male 74 years old Reason: increasing synthetic and intrinsic function tests per physician pt may have lung ca please eval liver for masses vs cirrhosis History: asymptomatic, rule out tumor infiltration LIVER: The liver measures 14.7 cm in length. The hepatic parenchyma is coarse and heterogeneous with nodularity of the hepatic contour, suspicious for chronic liver disease and cirrhosis. The main portal vein is patent and demonstrates normal directional flow. The peak velocity is 0.3 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is not identified. There is no intra-or extrahepatic biliary duct dilatation.PANCREAS: The pancreatic head and proximal body diffusely hyperechoic, presumably secondary to fatty replacement. The distal body and tail are not visualized due to bowel gas.KIDNEYS: The right kidney measures 12.3 cm. There is no hydronephrosis. The left kidney measures 12.6 cm. There is no hydronephrosis. OTHER: Mild splenomegaly measuring 14.3 cm. No evidence of ascites. | 1. Findings suggestive of chronic liver disease with cirrhosis and mild splenomegaly. |
Generate impression based on findings. | Exam is somewhat limited by difficulty in patient positioning.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The right parotid gland remains asymmetrically larger than the left but without surrounding inflammatory changes. The postcontrast appearance of the salivary glands is otherwise unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There are scattered blebs. Midline dorsal defects identified from C1 through C5. A syringo-subarachnoid catheter is visualized extending caudally from the upper aspect of the fourth ventricle. There is again a left occipital approach and a paucity catheter in stable position. The shunt catheter extends along the left neck and visualized anterior chest. Visualized ventricular caliber is unchanged. | Persistent asymmetric prominence of the right parotid gland as compared to lower volume left, without inflammatory changes to suggest sialadenitis. No evidence of cervical lymphadenopathy or mass. |
Generate impression based on findings. | 82-year-old male with history of headache. Evaluate for intracranial hemorrhage. No evidence of acute intracranial hemorrhage. Moderate periventricular and white matter hypoattenuation compatible with age indeterminate ischemic small vessel disease. The gray white differentiation is preserved. The ventricular configuration is age appropriate. The basal cisterns are intact. The orbits are unremarkable. Mild paranasal sinus mucosal thickening. The mastoid air cells are clear. The calvarium and scalp are unremarkable. | 1.No evidence of acute intracranial hemorrhage. 2.Moderate age indeterminate ischemic small vessel disease. |
Generate impression based on findings. | Nasopharyngeal mass on endoscopy; asymmetric lingual tonsil hypertrophy; globus sensation and choking for many years. Maxillofacial: There is mild diffuse prominence of the adenoids. There appear to be secretion within the left lateral nasopharyngeal recess. Otherwise, no discrete mass is discernible. The paranasal sinuses are clear. The nasal cavity is also clear. There is no significant nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. The mastoid air cells and middle ear cavities are clear. Neck: The palatine and lingual tonsils are unremarkable. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is multilevel degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. There are emphysematous changes in the imaged portions of the lungs. | 1. Diffuse nonspecific prominence of the adenoids. Although no discrete mass is discernible on CT, MRI of the nasopharynx may be useful for further evaluation.2. No evidence of sinusitis or mastoiditis.3. No evidence of significant lymphadenopathy in the neck. |
Generate impression based on findings. | Female, 59 years old, with CSF rhinorrhea, surgical planning examination for left frontal skull base repair. Evidence of endoscopic sinus surgery is redemonstrated. Again seen is a partially calcified nodule bridging a defect within the left posterior ethmoid region, adjacent to an area of left inferior frontal encephalomalacia. Findings are unchanged relative to prior.Also redemonstrated is opacification of the right middle ear cavity and mastoid air cells. The right tegmen tympani is dehiscent. Dehiscence of the lateral wall along the right sigmoid sinus is also redemonstrated.Scattered patchy areas of subcortical hypoattenuation are again seen. No evidence of parenchymal edema or mass effect is detected. No intracranial hemorrhage is seen. The ventricles are within normal limits.Mild mucosal thickening persists within the inferior maxillary sinuses similar to prior. | Multiple findings are redemonstrated including a partially calcified soft tissue nodule bridging a defect in the posterior left ethmoid region, dehiscence of the right tegmen tympani with opacification of the right middle ear cavity and mastoid air cells, and dehiscence of the lateral wall of the sigmoid sinus notch. |
Generate impression based on findings. | Lung cancer, evaluation of lung nodule. CHEST:LUNGS AND PLEURA: 16 x 10 mm irregular nodule in the inferior lingula containing fluid, soft tissue and lipid elements. Vascular structures and inferior to the lesion appear prominent, best appreciated on the high resolution images and there is a prominent vein leading from the lesion. No additional lesions or pleural fluid.MEDIASTINUM AND HILA: Normal heart size. No pericardial fluid. No conclusive coronary artery calcifications on this non-cardiac-gated study. Mildly prominent left hilar lymphatic tissue nonspecific, but no enlarged mediastinal or hilar lymph nodes.CHEST WALL: 8mm enhancing nodule in the right tracheoesophageal recess of the lower neck, posterior to the thyroid gland and medial to the right carotid artery. This is not isoattenuating to the thyroid gland and of unclear etiology as it is incompletely included scanning range, but possibly may arise from the thyroid.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion in the right hepatic lobe too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Indeterminate irregularly marginated nodule in the inferior lingula. If the patient does not have a tissue diagnosis of pulmonary neoplasm, differential considerations would include atypical appearance of an arteriovenous malformation in addition to neoplasm given the presence of an enlarged draining vein.2. Incompletely included in the scanning range is a subcentimeter enhancing nodule in the right cervical tracheoesophageal recess. This may be further assessed with neck CT if further characterization is required. |
Generate impression based on findings. | 76 years old, Female, Reason: eval for retroperitoneal bleed History: h/o metastatic small cell lung CA, retroperitoneal bleed ABDOMEN:LUNG BASES: Pleural based right lower lobe nodule measures 1.7 x 1.2 cm (series 4, image 9) and is not significant changed since prior study. Patchy groundglass opacity in the right lower lobe may represent scarring or atelectasis.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic tail abuts hematoma described in kidney section.ADRENAL GLANDS: Right adrenal nodule is not significantly changed in size. The left adrenal gland is definitely identified.KIDNEYS, URETERS: Bilateral renal cysts noted. Evolving hematoma persists in the left perirenal space appearing smaller in size. The larger hematoma is again identified abutting the pancreatic tail which appear significantly smaller in size measuring 4.2 x 8.0 cm (series 3, image 53). This hematoma abuts the splenic vein, left renal vein, and left renal artery, all of which appear patent.RETROPERITONEUM, LYMPH NODES: IVC filter with unchanged thrombus identified along both left lateral wall immediately above the junction of the common iliac veins. Partially calcified mural thrombus is again noted in the abdominal aorta extending just distal from the level of SMA about the iliac bifurcation is unchanged.BOWEL, MESENTERY: Moderate hiatal hernia. There is diffuse bowel wall thickening and fat stranding throughout the left colon which may be infectious in etiology. There is no definite evidence of a pneumatosis or free air. Diverticulosis without definite evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Atrophic or surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable appearance of T11 vertebral body lesion which is likely degenerative.OTHER: No significant abnormality noted | 1.Left upper quadrant hematoma abutting the pancreatic tail is significantly decreased in size compared to prior study.2.Evolving left perirenal space hematoma is also significant smaller.3.IVC filter with incompletely occlusive thrombus unchanged from prior study.4.Diffuse bowel wall edema the descending and sigmoid colon consistent with colitis. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is incidental cavum septum pellucidum et vergae. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable mild chronic small vessel ischemic changes. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. No significant thickening of the right maxillary sinus walls, suggestive of chronic inflammatory changes. | No acute intracranial abnormality. Stable minimal chronic small vessel ischemic changes. |
Generate impression based on findings. | LIVER: Diffusely decreased echogenicity of the liver suggestive of hepatitis. The liver is 16 cm in length. No focal hepatic lesion is identified. Hepatopetal flow with a main portal vein velocity of 20 cm/sec.GALLBLADDER, BILIARY TRACT: No gallstones. Diffuse gallbladder wall thickening measuring 6 mm. Murphy's sign is negative. No biliary ductal dilatation. CBD is 4 mm in diameter, within normal limits.PANCREAS: The pancreas is largely obscured by bowel gas.SPLEEN: Spleen is 7.9 cm in length with no focal lesion identified.KIDNEYS: Right kidney is 10 cm in length and left kidney is 11.7 cm. No hydronephrosis. OTHER: Small amount of ascites. | 1. Diffusely decreased liver echogenicity suggestive of hepatitis. 2. Gallbladder wall thickening, likely related to liver disease or hypoalbuminemia; acute cholecystitis is much less likely given negative Murphy's sign and no cholelithiasis. 3. Small amount of ascites. |
Generate impression based on findings. | 53-year-old female with history of left breast stereotactic core needle biopsy in 2011 demonstrating ADH. History of benign ultrasound guided left breast biopsy in 2009 with pathology of fibroadenoma. History of benign surgical excision of the right breast. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A ribbon clip is present in a stable mass in the left lower inner quadrant and an X shaped clip is present in the central left breast. Stable benign calcifications are present bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present in either breast. Benign lymph nodes are projected over both axillae. | Stable post biopsy changes in both breasts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 38 years old Reason: 1 year evaluation, post islet cell transplant , please evaluate portal vein History: 1 year evaluation, post islet cell transplant LIVER: The liver measures 18.5 cm. Normal echogenicity. No focal liver lesion identified. The main portal vein is patent and demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder. No biliary dilatation.PANCREAS: No significant abnormality in the visualized pancreas.KIDNEYS: The right kidney measures 10.0 cm. The left kidney measures 10.2 cm. There is no hydronephrosis.OTHER: The spleen measures 11.3 cm in length. | Patent portal vein with normal directional flow. |
Generate impression based on findings. | 64 year old female with left elbow, left knee, and back pain. Four views of the left elbow demonstrate tiny osteophytes, considered within normal limits for the patient's age. Otherwise, the bones appear normal. Alignment is within normal limits. No evidence of elbow joint effusion.Four views of the left knee, including weight-bearing, demonstrate minimal medial compartment joint space narrowing with tiny osteophytes, indicative of minimal osteoarthritis. No knee joint effusion. A 3-4 mm ossicle seen on the axial view only at the medial aspect of the patellofemoral joint could conceivably represent a loose body but this is equivocal. Minimal osteoarthritis affects the right knee as seen on the frontal view.Four views of the lumbar spine, including weight-bearing, demonstrate slight leftward curvature of the lumbar spine. Mild multilevel degenerative disk disease, greatest at L3-4. Mild facet joint arthritic changes greatest in the lower lumbar spine. Vertebral body heights are maintained. Alignment is within normal limits. Mild osteoarthritis of both hips noted. | Mild degenerative arthritic changes of the left elbow, left knee, and lumbar spine as described above. |
Generate impression based on findings. | Left shoulder displacementVIEWS: Left humerus AP and lateral, left shoulder internal and external rotation There is an acute fracture involving the humeral neck with minimal lateral displacement of the distal fracture fragment. No definite evidence of dislocation. There is associated marked soft tissue swelling. | Acute humeral neck fracture as described above. |
Generate impression based on findings. | Non-small cell lung cancer pre-chemo. CHEST:LUNGS AND PLEURA: Left upper lobe is collapsed by a centrally obstructing mass which is difficult to distinguish from adjacent collapsed lung, measuring approximately 5.4 x 5.3 cm on coronal image 91 and up to 5.7-cm on sagittal image 84. Small pleural fluid collections, left greater than right.Diffuse septal thickening throughout the right lung with irregular subsolid air space nodules in all lobes and bronchial wall thickening.Motion artifact in the left lower lobe precludes accurate assessment for subcentimeter metastases, and there two possible micronodules in the left lower lobe seen on series 5 image 61.MEDIASTINUM AND HILA: Moderate to severe diffuse mediastinal and hilar lymphadenopathy with encasement of the central bronchovascular structures and mild mass effect upon the left atrium. Small to moderate circumferential pericardial fluid collection with nodularity noted in the dependent aspect of the pericardium on the left distinct from adjacent lymph nodes.Reference subcarinal lymph node conglomerate measures 2.7-cm (3/45).Moderate coronary artery calcifications.CHEST WALL: Extensive low cervical, axillary and subpectoral lymphadenopathy bilaterally. Left internal mammary chain lymphadenopathy. Small cardiophrenic lymph nodes.Right chest port with tip at the SVC/RA junction.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating hepatic lesions too small to accurately characterize. Within the left hepatic lobe segments II, III and IVa, there are subtle areas of irregular hypoattenuation which are nodular in appearance which may cause subtle mass effect upon the hepatic capsule on the coronal sequence.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild para-aortic lymphadenopathy. Diffuse infiltrating soft tissue extending from it the gastrohepatic ligament at the level of the diaphragm (3/84) in a contiguous fashion surrounding the celiac axis and extending into the portocaval region.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Innumerable small to moderately enlarged mesenteric lymph nodes. Mesenteric fat stranding. Mild thickening of the fascial planes throughout the abdomen with scattered subcentimeter nodules.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Left upper lobe mass measures at least 5.7-cm, extending to the hilum and causing lobar collapse.2. Finding suspicious for lymphangitic tumor spread throughout the right lung. Additional nodules in the right lung are compatible with metastases.3. Small pleural and pericardial fluid collections.4. Diffuse mediastinal, hilar and chest wall lymphadenopathy.5 Confluent lymphadenopathy throughout the upper abdomen. Mesenteric lymphadenopathy, fat stranding and nodularity.6. Indeterminate hepatic abnormality suspicious for underlying metastases. This may be further characterized by dedicated hepatic CT if diagnoses would alter clinical management.7. No evidence of skeletal metastases. |
Generate impression based on findings. | Male 41 years old Reason: hx of gastric cancer s/p resection, now s/p 2 months adjuvant chemotherapy. Restaging. History: none CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Unchanged prominent right hilar node.CHEST WALL: Right chest Port-A-Cath with tip terminating at cavoatrial junction. Mild bilateral gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypoattenuating lesion in hepatic segment 6 measures 1.4 x 2.6 cm (image 93, series 3), which was equivocally present on the prior examination and may reflect focal fat although metastasis is not excluded. Additional hepatic hypodensities are identified, but incompletely characterized.SPLEEN: Subcentimeter splenic hypodensity is too small to characterize, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There is mild dilatation of the proximal celiac axis.BOWEL, MESENTERY: Postsurgical changes related to total gastrectomy with Roux-en-Y esophagojejunostomy and jejunojejunostomy. There is no evidence of bowel obstruction. There is no evidence of local lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No definite metastases identified.2.Hypoattenuating lesion in the right hepatic lobe, which may reflect focal fat, although metastatic disease is not excluded. This lesion was not hypermetabolic on the prior PET examination, although appears slightly more conspicuous on today's exam. Further evaluation with MRI can be considered as clinically indicated. |
Generate impression based on findings. | 6 year-old female. History of Wilms tumor status post chemotherapy. LIVER: Normal echogenicity. No focal hepatic mass is identified. The liver is 11 cm in length.GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation. No cholelithiasis or gallbladder wall thickening.PANCREAS: The pancreatic head and neck demonstrates normal echogenicity. The remainder of the pancreas is obscured by bowel gas.SPLEEN: Spleen is 8 cm in length. Small accessory splenule is again noted.KIDNEYS: Status post right nephrectomy with no residual/recurrent mass identified. Left kidney is 9.6 cm in length. No hydronephrosis, focal mass, or shadowing stone.ABDOMINAL AORTA: No aortic aneurysm is identified. The aorta is 1.3 cm in diameter.INFERIOR VENA CAVA: Patent with appropriate waveform.OTHER: Unremarkable appearance of the bladder. | Status post right nephrectomy with no evidence of recurrence. |
Generate impression based on findings. | No definite intra-axial or extra-axial mass is identified. There is focal T1 and T2 hypointensity along the frontal convexities, more than than on the right with a plaque like appearance. Findings are best visualized on coronal T2 and sagittal T1-weighted images. There is no corresponding enhancement. These are felt to likely relate to incidental dural calcifications.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is incidental developmental venous anomaly in the posterior right frontal centrum semiovale. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is redemonstration of a pineal T2/FLAIR hyperintense cystic structure which measures 10-mm transverse by 13-mm AP by 9 mm CC. There is no associated enhancement, other than for probable normal pineal tissue peripherally. The remainder of the midline structures and craniocervical junction are within normal limits. | 1. No definite focal extra-axial mass. Areas of plaque-like hypointensity along the frontal convexity dural margin which more likely represent asymmetric dural mineralization given its bilaterality. CT could be obtained for confirmation.2. Stable size of incidental simple appearing pineal cyst measuring slightly greater than 1 cm. |
Generate impression based on findings. | FractureVIEWS: Right elbow AP, oblique and lateral There is a screw through the medial epicondyle new from prior study. There is periosteal reaction along the distal humerus reflecting interval healing. A small bony fragment is seen immediately anterior to the distal humerus not significantly changed. The overlying splint has been removed in the interval. | Interval fixation medial epicondyle fracture as described above. |
Generate impression based on findings. | Female; 51 years old. Reason: eval for degenerative changes History: right hip pain Single AP view of the pelvis with two views of both hips demonstrate minimal narrowing of the left hip joint and tiny osteophytes, indicating minimal left hip osteoarthritis. No significant osteoarthritis of the right hip is evident. The right hip Tonnis angle measures approximately 13-14 degrees, which may reflect mild acetabular underdevelopment. The right hip lateral center edge angle measures approximately 25 degrees, which is at the lower spectrum of normal. | Minimal left hip osteoarthritis and perhaps mild right hip dysplasia as described above. |
Generate impression based on findings. | Adenovirus difficulty breathingVIEW: Chest AP Cardiothymic silhouette normal. The patchy opacities in the lingula not significantly changed. There is new atelectasis in the right upper lobe. No pleural effusion or pneumothorax. | Patchy opacities in the lingula not significantly changed with new atelectasis in the right upper lobe. |
Generate impression based on findings. | 75-year-old male status post L4/5 fusion There are posterior rods with screws entering the L4 and L5 vertebral bodies. No hardware complication is evident. A spacer device is present at C4/5 with associated bone graft material. Small anterior osteophytes are present along the vertebral bodies. The bones are slightly demineralized. Gas in the posterior soft tissues likely reflects recent surgery. Air-filled loops of small bowel may reflect postoperative ileus. | Postoperative changes of L4/5 fusion as described above. |
Generate impression based on findings. | Female; 54 years old. Reason: PAIN History: PAIN Three views of the right wrist demonstrate interval removal of overlying cast. There is mild soft tissue swelling about the wrist. Slight demineralization of the bones, which may be due to disuse. Comminuted, mildly impacted distal radius fracture with intra-articular extension is again seen in near anatomic alignment. Mild callus formation adjacent to the fracture, compatible with some interval healing. Associated mildly displaced ulnar styloid fracture is also again seen. | Distal radius and ulnar fractures as described above. |
Generate impression based on findings. | 75-year-old male with right knee pain There is mild sharpening of the tibial spines and minimal medial joint space narrowing. There may be a small joint effusion, but this is equivocal. Similar findings affect the left knee as seen on the frontal view. | Minimal osteoarthritis essentially within normal limits for the patient's age. |
Generate impression based on findings. | 70 year-old female with pain Soft tissue swelling is present along the lateral aspect of the joint. No fracture is evident. | Soft tissue swelling without fracture evident. |
Generate impression based on findings. | 52 year-old female status post C5-6 ACDF The cervicothoracic junction is not well seen on the lateral view due to overlying anatomy. There is an anterior plate with screws entering the C5 and C6 vertebral bodies. No hardware complication is evident. Bone graft is noted at the C5/6 disk space. Alignment is within normal limits. | Postoperative changes of C5/6 ACDF. |
Generate impression based on findings. | Male 65 years old; Reason: assess for ileus History: bilious output from ng tube Enteric tube terminates underneath the left hemidiaphragm in the region of the proximal gastric body.The bowel gas pattern is nonobstructive. | 1.Enteric tube terminates in the region of the proximal gastric body. |
Generate impression based on findings. | 75 year old female with history of non-small cell lung cancer. CHEST:LUNGS AND PLEURA: Mild apical predominant emphysema. Minimal atelectasis of the lingula. Stable scattered pulmonary micronodules, some of which are calcified. No pleural effusion, consolidation, or new masses. Postoperative findings in the right upper lobe, unchanged.Right upper lobe reference lesion (4/22) measures 12 x 10 mm, unchanged.MEDIASTINUM AND HILA: Heart size within normal limits, with no significant pericardial effusion. Severe coronary artery calcifications, and scattered mediastinal/hilar lymph nodes.CHEST WALL: Heterogeneous and nodular thyroid, with coarse calcifications in the right thyroid lobe, unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic lobe hypoattenuating focus, likely a benign cyst, unchanged. Mildly dilated intrahepatic and extrahepatic bile ducts, not uncommon in patients post cholecystectomy.SPLEEN: No significant abnormality noted, unchanged.ADRENAL GLANDS: Left adrenal nodule is unchanged in size, measuring 18 mm (3/85).KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Nodularity of the right upper lung suture line is unchanged.2.No lymphadenopathy or new suspicious nodules/masses. |
Generate impression based on findings. | 56-year-old male, history of fall, unable to move left upper extremity Mild osteoarthritis affects the shoulder. We see no acute fracture or dislocation. A couple of old left healed rib fractures are identified. | No acute fracture or dislocation. |
Generate impression based on findings. | 80-year old female with right breast cancer. Lymphoscintigraphy needed for right sentinel lymph node biopsy.RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. Several foci of increased activity are noted in the right axilla, representing the sentinel nodes. The region with the initial and most intense activity was marked with an indelible marker. | Sentinel nodes identified in the right axilla. |
Generate impression based on findings. | 73 year old female with history of benign stereotactic core needle biopsy 8/2011 revealing apocrine metaplasia, calcium oxalate and focal fibroadenomatoid change. History of ovarian cancer in sister and breast cancer in maternal niece. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A percutaneously placed clip is present in the left upper outer quadrant with interval decrease in size of the density associated with the clip. Left lower inner breast mass with associated calcifications which layer on the ML view consistent with a cyst is also smaller compared to the previous examination.No suspicious masses, microcalcifications or areas of architectural distortion are present in either breast. Stable lymph nodes project over the axillae. | Interval decrease in the size of left breast masses. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 16 year-old female with recurrent ALL and necrotizing pancreatitis. Evaluate for LLQ fluid collection. ABDOMEN:LUNG BASES: No significant abnormality noted. Central venous catheter tip in the right atrium.LIVER, BILIARY TRACT: No focal hepatic lesion is identified. No biliary ductal dilatation. Hyperattenuating foci anterior to the gallbladder and falciform ligament, unchanged and likely dystrophic calcifications. Portal vein is patent. Trace perihepatic fluid.SPLEEN: No significant abnormality notedPANCREAS: The pancreas is moderately atrophic with sparing of the head. Mildly enlarged peripancreatic nodes, not significantly changed. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. Punctate nonobstructive renal stones bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval removal of jejunal tube. Clips are noted in the stomach. Small amount of nonloculated mesenteric fluid in the left abdomen (series 3, image 82).BONES, SOFT TISSUES: Injection granulomas in the anterior abdominal wall. Demineralized bones. Multilevel compression deformities in the thoracolumbar spine, unchanged.OTHER: Previously seen loculated perisplenic fluid collection extending down the left paracolic gutter has undergone drainage by a percutaneous pigtail catheter terminating in the left lower abdomen. No remaining measurable collection is identified. There is inflammatory stranding/scarring in the left hemiabdomen posterior to the descending colon.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status post appendectomy.BONES, SOFT TISSUES: Demineralized bones. Multilevel compression deformities in the thoracolumbar spine, unchanged.OTHER: Small amount of nonloculated fluid in the cul-de-sac that is bilobed and extends into the right hemipelvis just inferior to the cecum, new from prior exam. No rim enhancement of this fluid is evident. | 1. Significantly decreased size of left perisplenic collection, which has undergone interval drainage. No measurable residual collection.2. Interval development of small amount of nonloculated fluid in the cul-de-sac extending into the right hemipelvis. Small amount of mesenteric fluid. |
Generate impression based on findings. | Male 46 years old Reason: POEMS syndrome, ?organomegaly History: POEMS syndrome, abdominal distention with superficial venous pattern over abdomen.Hypercoagulable state on warfarin LIVER: The liver measures 18.5 cm. The parenchyma is echogenic and heterogeneous, as noted on prior study but no definite mass is identified. This is nonspecific but may relate to fatty infiltration. The portal vein is patent and demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without cholelithiasis, wall thickening or pericholecystic fluid. There is no biliary dilatation.PANCREAS: The pancreas is poorly visualized due to bowel gas.KIDNEYS: The right kidney measures 12.8 cm. The left kidney measures 13.1 cm. There is no hydronephrosis. The left kidney is poorly visualized.OTHER: The spleen measures 10.6 cm. | Heterogeneously echogenic hepatic echotexture which may relate to fatty infiltration. No focal mass is identified however sensitivity is reduced in the presence of diffuse fatty infiltration. No other evidence of organomegaly. |
Generate impression based on findings. | 63 years old, Male, Reason: restaging CT after gastric cancer resection (R1) s/p adjuvant CRT completed 4/2013. Compare to 12/2013 scan. History: none CHEST:LUNGS AND PLEURA: Scattered micronodules. No suspicious pulmonary nodules or masses are identified.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes not meeting size criteria for lymphadenopathy. No hilar lymphadenopathy.CHEST WALL: Interval removal of right chest port.ABDOMEN:LIVER, BILIARY TRACT: Right lobe segment 5 subcentimeter hypodensity is new from prior study and is suspicious for metastasis. Recommend MRI for further evaluation of this lesion. Unchanged nonspecific subcentimeter hypodensity in the right hepatic lobe which may represent a simple cyst. No new lesions or biliary ductal dilatation. Fatty infiltration of the liver. Hepatojejunostomy.SPLEEN: No significant abnormality notedPANCREAS: Fatty pancreatic atrophy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Previously described mesenteric haziness adjacent to the celiac axis is not as prominent on this study. Scattered retroperitoneal lymph nodes are unchanged in appearance.BOWEL, MESENTERY: Stable postoperative changes of a gastrojejunostomy. Normal caliber bowel loops without obstruction, wall thickening, or fluid collections.BONES, SOFT TISSUES: Mild degenerative changes of the lumbar spine are unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Single new lesion in the right lobe of the liver which is new from prior study and suspicious for metastasis. Recommend liver MRI for further evaluation. |
Generate impression based on findings. | 11-year-old male with left knee pain with "pop" sounds for 3 weeks, basketball player for 4-5 years, no clear history of injury. Ankle pain with walking for 2 weeks.VIEWS: Left knee AP/lateral/oblique, left ankle AP/lateral/oblique, right ankle AP/lateral/oblique (9 views), 1/9/2015, 1027 hrs. Left knee:No joint effusion. No evidence of fracture or malalignment in the left knee.Left ankle:No joint effusion. Ankle mortise appears intact. No evidence of fracture or malalignment.Right ankle:No joint effusion. Ankle mortise appears intact. No evidence of fracture or malalignment. | Normal examination. |
Generate impression based on findings. | 69-year-old male with history of non-small cell lung cancer now with worsening performance status. LUNGS AND PLEURA: Right upper lobe mass (4/32) measures approximately 39 x 37 mm, previously 39 x 39 mm. In the coronal plane, the lesion currently measures 59 mm, previously 64 mm. Adjacent atelectasis limits accuracy of measurement. Loculated right pleural effusion has decreased in size. Moderate emphysema. Thickening of the right upper lobe airways, about the same. The the right main bronchus, proximal right lower lobe bronchus and bronchus intermedius are thickened, unchanged.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy are again seen, with reference right lower paratracheal/R4 lymph node (4/39) measuring approximately 9 mm in the short axis, previously 14 mm.Right hilar lymph node (4/45) measures 19 mm, previously 25 mm.There is mild to moderate mass effect upon the distal right main pulmonary artery by adjacent lymphadenopathy.Heart size within normal limits, and no pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Bilateral axillary lymph nodes are similar to prior. Bilateral low cervical lymphadenopathy has improved.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Necrotic right upper lobe mass measures slightly smaller than previous exam however adjacent atelectasis and coarse interstitial abnormality appears worse..2.Improving lymphadenopathy.3.Small right pleural effusion has decreased in size. |
Generate impression based on findings. | 67 years old, Male, Reason: history of cholangiocarcinoma s/p resection (R1) 7/19/12 s/p adjuvant CRT completed 4/2013. Evaluate for recurrence. History: none CHEST:LUNGS AND PLEURA: Stable nonspecific thickening of the minor fissure. Bibasilar atelectasis. No suspicious pulmonary masses or nodules.MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes not meeting size criteria for lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Pneumobilia of likely related to previous biliary bypass. No focal hepatic mass. The previously described infiltrative change in the porta hepatis fat appears stable.SPLEEN: No significant abnormality notedPANCREAS: Previously described infiltrative change adjacent to the pancreatic head and portal vein is stable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Previous described portacaval lymph node is not significantly changed measuring 1.3 x 0.6 cm (is 3, image 86), previously measuring 0.7 x 1.4 cm.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral fat containing inguinal hernias.OTHER: No significant abnormality noted | 1. Stable examination without evidence of recurrent disease or distant metastasis.2. Bilateral fat containing inguinal hernias. |
Generate impression based on findings. | Recall from screening mammogram for calcifications in the right upper outer quadrant. A ML view and 3 spot magnification views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Magnification views confirm a 3 cm group of linearly oriented calcifications near the 12 o'clock position of the right breast.No associated masses or areas of architectural distortion are present. | Suspicious calcifications in the right breast. Stereotactic core needle biopsy is recommended. Results and recommendations were discussed with the patient and Dr. Patricia Kurtz.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | Female 37 years old Reason: evaluate vasculature to support kidney transplant History: history of 2 kidney transplants with 2 tx nephrectomies ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: There are severe atherosclerotic calcifications of the splenic artery.PANCREAS: The pancreatic tail is seen high in the left upper quadrant, the shape and position of which is irregular. While nonspecific, this morphology is felt to most likely be congenital in etiology, further evaluation MRI could be considered as clinically indicated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys are atrophic. There is a dense calcification in the superior pole the left kidney.There is an atrophic partially calcified soft tissue mass in the left iliac fossa, likely reflecting a rejected kidney transplant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There are coarse atherosclerotic calcifications of the bilateral external, internal and common carotid arteries as well as the abdominal aorta. | 1.Coarse atherosclerotic calcifications of the bilateral external, internal and common iliac arteries as well as the abdominal aorta. 2.Pancreatic tail seen high in the left upper quadrant, the shape and position of which is irregular. Although felt most likely congenital in etiology, MRI can be considered for further evaluation as clinically indicated. 3.Rejected transplant kidney in the left iliac fossa. |
Generate impression based on findings. | 84-year-old female with history of lung cancer. Restaging exam. Additional history per EPIC "Stage IV adenocarcinoma lung with mets to the brain s/p only XRT to lung, R neck venous thrombus". LUNGS AND PLEURA: Centrally necrotic right hilar mass with epicenter in the lower lobe measuring 6.3-cm in maximal length (coronal image 33) and 5.3 x 3.8 cm in transaxial dimensions (3/46). Mass is inseparable from the right main bronchus and right lower lobe proximal airways and be fat of the posterior mediastinum. Mediastinal invasion and narrowing of the bronchus intermedius and right lower lobe bronchus is present. Adjacent distal obstructive atelectasis.Left upper lobe solid pulmonary nodule (4/24) measuring 12 x 12 mm with low central attenuation that may represent necrosis. Minimal dependent atelectasis/scarring, some of which may be related to radiation therapy, and scattered pulmonary micronodules, some of which are calcified.Small right pleural effusion. MEDIASTINUM AND HILA: The right hilar mass invades the mediastinum, and there is adjacent mediastinal and hilar lymphadenopathy, some of which show central necrosis. High and low paratracheal, paraesophageal, subcarinal, right hilar and inferior interlobar lymph nodes are moderately enlarged. A reference inferior interlobar lymph node measures 15 mm in the short axis (3/48).Heart size within normal limits, and there is no appreciable pericardial effusion. Moderate coronary artery calcifications. Left subclavian venous catheter tip in the SVC, with right IJ venous thrombus.CHEST WALL: Degenerative changes affect the visualized spine. Scattered small bilateral axillary lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Bilateral renal cysts, unchanged. Indeterminate left adrenal gland nodule (3/80). The wall of the proximal stomach appears thickened on the image 76, incompletely assessed. | Right hilar necrotic mass with mediastinal invasion and associated lymphadenopathy as above. Indeterminate left adrenal gland nodule. |
Generate impression based on findings. | Thyroid cancer, hilar mass on CT and PET. LUNGS AND PLEURA: Suture lines from prior resections and main right middle and left upper lobes.No fluid or pneumothorax. Unchanged two to 3-mm calcified and noncalcified micronodules in the right lower lobe. No new nodules are appreciated.MEDIASTINUM AND HILA: Left lower paratracheal lymph node has increased in size, 2.7 by 2.1-cm compared to 2.3 by 1.4-cm previously. (described as AP window previously).Unchanged 12-mm lymph node in the right hilum (4/56). Small partially calcified subcarinal lymph nodes unchanged.No pericardial fluid. Normal heart size.CHEST WALL: Postsurgical changes of thyroidectomy and left axillary dissection.Healed left posterior rib fracture deformities.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Lower left paratracheal lymphadenopathy measures larger. No new sites of disease are appreciated. |
Generate impression based on findings. | 61 years Male Reason: r/o liver path History: asymptomatic; hep B carrier LIVER: Estimated length of 13.2 cm. Coarse heterogenous echotexture is again noted without focal lesions. Patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. Common bile duct measures 0.4 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Estimated length of 10.9 cm. No hydronephrosisOTHER: The left kidney measures 10.4 cm. No significant abnormalities noted. Spleen measures 8.7 cm. | Coarsened heterogenous echotexture compatible with chronic liver disease without focal lesion. No substantial interval change compared to prior. |
Generate impression based on findings. | 52 year-old female with history of right lumpectomy and sentinel node biopsy in May 2011 after neoadjuvant chemotherapy for right breast invasive ductal carcinoma. Patient is status post radiation therapy. Three standard views of both breasts and a right laterally exaggerated CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Linear markers were placed on scars overlying the right breast.Surgical clips in the right upper outer breast and right axilla are present with associated stable postsurgical changes of volume loss and distortion. Scattered benign calcifications, including an oil cyst in the right retroareolar region, are present. No new masses, suspicious microcalcifications, or new areas of architectural distortion are present in either breast. | Stable postsurgical changes in the right upper outer breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 50 years old Reason: assess for esophageal dysfunction History: pain and difficulty swallowing Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. There is mild proximal escape and tertiary contractions involving the mid esophagus. No reflux was elicited.Evaluation of the cervical esophagus shows postsurgical changes with anterior plate and screw fixation of C5 and C6 with interbody graft.There is a prominent osteophyte at the anterior right aspect of the C4-5 disk space that causes mild mass effect upon the posterior aspect of the larynx and esophagus.TOTAL FLUOROSCOPY TIME: 3:58 minutes1. | 2.Esophageal motility disorder with proximal escape and tertiary contractions.3.Osteophyte at the C4-5 disk space that impresses upon the posterior aspect of the larynx. |
Generate impression based on findings. | Follow up bilateral spiculated nodules, no diagnosis (TBBX, FNA attempted). LUNGS AND PLEURA: Severe upper lobe predominant centrilobular and paraseptal emphysema. Bilateral scarlike lesions in the upper lobes containing nodularity and spiculation.Left upper lobe lesion increased in size, measuring 4.1 x 3.3-cm (5/23), previously 1.6 x 2cm. Subsegmental bronchus within the lesion is occluded. Nodularity along some of the spiculations also noted. There is a new metallic density near the lesion which appears to be a fiducial marker.Right upper lobe lesion measures 2.2 x 1.2 cm, previously 2.3 x 1.4 cm (5/28).Second right upper lobe lesion measures 10 x 7 mm, previously 10 x 8 mm (5/33).Additional right lung nodules are unchanged (5/23).No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Densely calcified right infrahilar region lymph nodes unchanged. Unchanged small mediastinal lymph nodes with no suspicious-appearing lesions identified.The ascending aorta is mildly ectatic measuring 43-mm in AP dimension. Severe coronary artery calcifications. Atherosclerotic calcification of the aorta and its branches.CHEST WALL: T8 vertebral body compression fracture, chronic.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcification of the SMA. | 1. Increase in size of left upper lobe mass; growth and lobulated appearance are consistent with malignancy. The presence of fiducial markers raises the question of interval RT which could result in overestimation of lesion size.2. Additional lesions measured stable to minimally smaller and should continue to be monitored to exclude malignancy, though relative stability over the last year favors a benign process.3. No lymphadenopathy.4. Mild ectasia of the ascending aorta. |
Generate impression based on findings. | History of right lumpectomy in 2006 for infiltrating ductal carcinoma. Patient received radiation and Arimidex. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round marker was placed on a skin lesion overlying the left breast. Linear markers were placed on scars overlying the right breast. Stable postsurgical architectural distortion, volume loss, dystrophic calcifications and surgical clips are present in the right lumpectomy bed.No new masses or suspicious microcalcifications are present in either breast. Benign lymph nodes are projected over the left axilla. | Stable post surgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male; 30 years old. Reason: eval for fx History: pain after fall, scd Five nonweightbearing views of the left knee demonstrate osteonecrosis of the left distal femur resulting in fragmentation of the articular surface of the medial femoral condyle, grossly similar to prior study from 12/13/14. In addition to the ossicles within the defect in the medial femoral condyle, there is a 2-cm ossicle at the posterior aspect of the left tibial plateau, which may represent a loose body. No evidence of acute fracture or malalignment. No large knee joint effusion.Two views of the left femur demonstrate the aforementioned changes of the left distal femur and knee. The bones are slightly demineralized. No acute fracture or malalignment is evident. | Osteonecrosis of the left distal femur with potential loose body as described above and similar to prior study. No acute fracture or malalignment is evident. |
Generate impression based on findings. | 47 years old, Male, Reason: eval for GI bleeding History: low hemoglobin with abdominal distention Lack of IV contrast limits evaluation of abdominal parenchyma and vessels. Within these limitations the following observations are made:ABDOMEN:LUNG BASES: Bibasilar atelectasis and trace left pleural effusion.LIVER, BILIARY TRACT: Diffuse hepatic steatosis. Lack of IV contrast hepatic steatosis limits evaluation for focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No right renal hypodensity is incompletely characterized on this study but is previously seen to be a cyst on prior MRI. Right nonobstructing nephrolithiasis.RETROPERITONEUM, LYMPH NODES: IVC filter in the infrarenal IVC. Asymmetry of the retroperitoneum with enlarged left psoas muscle and soft tissue attenuation on the left para-aortic area which likely represents a retroperitoneal hematoma measuring 7.9 x 4.1 cm.BOWEL, MESENTERY: The small bowel is normal in caliber, however has foci of air within the bowel loops. Dilated colon to 9.1 cm without evidence of obstruction, consistent with known postop ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noteBOWEL, MESENTERY: The small bowel is normal in caliber, however has foci of air within the bowel loops. Dilated colon to 9.1 cm without evidence of obstruction, consistent with known postop ileus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Left retroperitoneal hematoma.2. Dilated colon likely represents postop ileus. 3. Diffuse hepatic steatosis.Discussed findings with Dr. Gina Bradley at 11:30 on 1/9/14 |
Generate impression based on findings. | 21-year-old male with history of Ewing sarcoma, now off therapy.VIEWS: Chest PA and lateral (two views), left tibia/fibula AP/lateral (two views) 1/9/2015, 1043 hrs. Chest:No focal pulmonary opacity, pleural effusion, or pneumothorax. Normal cardiothymic silhouette.Left tibia/fibula:Distal fibular resection and anchors in the distal tibia redemonstrated. No soft tissue or osseous lesion is identified. | No evidence of disease recurrence or metastasis. |
Generate impression based on findings. | Male 55 years old Reason: evaluate vasculature to support kidney transplant History: poor/absent distal pulses ABDOMEN:LUNG BASES: Calcified right upper lobe nodule suggestive of prior granulomatous disease. There are atherosclerotic calcifications of the coronary arteries.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesion in the superior pole of the left kidney consistent with a simple renal cyst. There is moderate perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: There are moderate atherosclerotic calcifications of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: There is mild circumferential bladder wall thickening, which is nonspecific, but correlation for possible cystitis recommended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There are mild atherosclerotic calcifications of the bilateral common iliac arteries. There are moderate atherosclerotic calcifications of the internal iliac arteries and their branches. There are trace atherosclerotic calcifications of the left external artery, and no significant atherosclerotic calcifications of the right external iliac artery. | 1.There are mild atherosclerotic calcifications of the bilateral common iliac arteries. There are moderate atherosclerotic calcifications of the internal iliac arteries and their branches. There are trace atherosclerotic calcifications of the left external artery, and no significant atherosclerotic calcifications of the right external iliac artery.2.Mild circumferential bladder wall thickening, nonspecific but correlation to exclude possible cystitis is suggested. |
Generate impression based on findings. | Right nasal adenocarcinoma status post resection of tumor 10/7/13, then ethmoidectomy with probable T2N0 squamous cell carcinoma treated with chemoradiation. There are postoperative findings related to sinonasal tumor resection. There is persistent diffuse opacification of the paranasal sinuses, mainly in the form of mild to moderate mucosal thickening. There is sclerosis of the residual septations within the right ethmoid cavity. There are scattered linear opacities in the nasal cavity, which may correspond to secretions or synechiae. There is minimal residual stranding of the right cheek and preseptal fat. The right pterygomaxillary fossa appears unchanged. There is no definite mass lesion. The middle ear cavities and mastoid air cells are essentially clear. The orbits and intracranial structures are unremarkable. | Postoperative findings related to sinonasal tumor resection with persistent diffuse paranasal sinus opacification without definite recurrent tumor. |
Generate impression based on findings. | Male 67 years old Reason: 67 year old male with history of necrotizing pancreas. Complicated pseudocyst formation and drain pulled in clinic on 12/19/14. F/u CT Scan ion 3 weeks. History: abdominal pain This study is limited due to lack of intravenous contrastABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis is unchanged. Subcentimeter hypodensities in the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: Patient's known peri-splenic collection near the tail of the pancreas has been drained with in the interval and near completely resolved. Small amount of residual collection measures 3.5 cm x 3.2 on image number 38, series number 3.The collection extends inferiorly throughout the retroperitoneum and extending into the posterior left abdominal wall. This collection has also decreased in size compared to previous study. Gastric stent is again noted. Atrophic pancreas is not well seen and can be differentiated from the surrounding fluid on this noncontrast study.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Again seen atrophic kidneys with numerous hypodense lesions of various size and density. Lack of IV contrast precludes optimal characterization of these lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Transplant kidney in the right lower quadrant.OTHER: No significant abnormality noted | Limited study due to lack of intravenous contrast. Internal drainage and near complete resolution of the peri-splenic fluid collection. Left retroperitoneal collection has also decreased in size compared to previous study. Other findings are stable. |
Generate impression based on findings. | T4aN3M1 squamous cell carcinoma of the base of the tongue with lung metastases. There is no significant change in size of the ill-defined right tongue base lesion, which measures up to approximately 20 mm. However, there is interval increase in size and heterogeneity of the adjacent left lingual tonsil, There is no significant interval change in bilateral cervical lymphadenopathy. For example, a right level 2 lymph node measures 12 mm, previously 12 mm and a left level 2 lymph node measures 11 mm in short axis, previously 11 mm. The thyroid and major salivary glands are unchanged. The left internal jugular vein is absent. There is mild right and moderate left atherosclerotic plaque at the carotid bifurcations. The osseous structures are unchanged. The airways are patent. There is moderate mucosal thickening within the left mastoid air cells. The imaged intracranial structures are unremarkable. There is an unchanged right apical subpleural based lesion. | 1. Although the right tongue base lesion does not appear to be significantly changed, there is interval increase in size of the left lingual tonsil, which is nonspecific, but tumor progression cannot be excluded.2. No significant interval change in the treated bilateral cervical lymphadenopathy. 3. Unchanged right apical subpleural based metastatic lesion. |
Generate impression based on findings. | Tonsillar squamous cell carcinoma, status status post chemoradiation. Also history of lung and prostate cancers. Again seen are posttreatment changes of chemoradiation with interval improvement in previously seen supraglottic edema. No appreciable airway narrowing. There is no evidence of mass lesions or significant cervical lymphadenopathy in the neck. Fatty atrophic changes are noted involving the bilateral submandibular and the left parotid gland compatible with treatment change. Again seen are punctate calcifications within the enlarged left thyroid gland. The major cervical vessels are patent with mild plaque at the carotid bifurcations and a right internal jugular venous catheter. Mild mucosal thickening in the left maxillary sinus with small mucous retention cyst. There is multilevel degenerative spondylosis with moderate to severe neural foraminal stenosis. There is persistent partially imaged right upper lobe consolidation with air-bronchograms.Brain parenchyma is unremarkable for age without evidence of mass, mass effect, or abnormal enhancement to suggest metastatic disease. No extra-axial collections. No hydrocephalus. | 1. No evidence of mass lesions or significant cervical lymphadenopathy in the neck.2. Partially imaged right upper lobe consolidation with air-bronchograms similar to prior . Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Reason: Evaluate for subluxation History: neck trauma The patient has an os odontoideum. The patient is status post posterior fusion and laminectomies at C1 - C2. Cerclage wires are noted at C1 -C2. No osseous bridging is noted at the fusion site.Compared to the previous exam, the alignment between C1 and C2 has changed. The anterior arch of C1 as well as the os odontoideum have migrated posteriorly relative to the rest of the C2 vertebral body. There is no compromise of the cervical spinal cord at C1-2.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. | 1.The patient has an os odontoideum. The patient has undergone posterior fusion at C1-2. No osseous fusion is noted. Since the previous examination the alignment between C1 and C2 has changed. The anterior arch of C1 as well as the os odontoideum are subluxed posteriorly relative to the C2 vertebral body. There is no associated compromise to the cervical spinal canal at this level however. Please note that extension/flexion plain film views may provide more insight on stability. |
Generate impression based on findings. | Lung cancer status post radiation check response CHEST:LUNGS AND PLEURA: Interval progression of post therapeutic of volume loss related to radiation therapy. The solid component of the index right upper lobe nodule measures 2.5 x 1.3 cm (5/35), previously 0.7 x 0.9 cm.The associated thin walled cyst is unchanged however surrounding radiation reaction has increased. Obstruction of some of the peripheral airways leading into this area has progressed, with the area of obstructing soft tissue measuring 18 x 13 mm, not present previously (5/37).Right lower lobe cystic mass continues to have enlargement of the cystic component, now measuring 2.6 x 5.4 cm, previously 2.4 x 4.8 cm. The previously solid medial component of the lesion now appears entirely cystic. Surrounding consolidation has linear borders, most consistent with radiation reaction.9 mm nodule at the right apex has increased in size, previously 4-5 mm.Left apical scarlike opacity unchanged (5/14).Severe emphysema and innumerable clustered cystic and groundglass lesions in the periphery of the right long which maybe related to radiation superimposed upon emphysema but are of unclear etiology..MEDIASTINUM AND HILA: Atherosclerotic calcifications of the thoracic aorta and its branches. Very small bulge upon the inferior margin of the aortic arch is unchanged. Severe coronary artery calcifications. Normal heart size. No pericardial fluid or lymphadenopathy.CHEST WALL: Diffuse osteopenia. Thin-walled fat-containing nodules in the lateral aspect of the right breast unchanged over multiple prior studies. T8 vertebroplasty.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys appear atrophic on with vascular calcifications. Right renal cyst.PANCREAS: Scattered pancreatic calcifications may indicate chronic pancreatitis or could be vascular.RETROPERITONEUM, LYMPH NODES: Intrarenal IVC filter with a strut penetration into the surrounding fat unchanged. Large and upper renal aortic aneurysm with maximal AP dimension of 5.7-cm (3/108), previously 5.4-cm at the same level. On the sagittal sequence, the aneurysm measures 7.2-cm craniocaudal. Severe atherosclerotic calcification throughout the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Superior endplate compression deformities of L2 and L3 vertebral bodies.OTHER: No significant abnormality noted. | 1. Assessment of the peripheral right upper lobe lesion is complicated by superimposed radiation reaction. The solid components appear larger and produces occlusion of the adjacent airways. Correlation with PET scan is suggested to distinguish active tumor from radiation reaction. Measurements are provided in the body of the report.2. Large cystic mass lesion in the right lower lobe has probably improved as the solid component is now cystic. This is also surrounded by consolidation which most likely represents radiation reaction.3. Persistent subcentimeter right apical nodule contains both lipid and fluid elements, raising possibility that this could reflect an enlarging subpleural lymph node, though not specific. This should continue to be monitored.4. Large infrarenal aortic aneurysm now measuring 5.7-cm in AP dimension. This has slightly increased from prior measurement of 5.4-cm. |
Generate impression based on findings. | Humeral fractureVIEWS: Left shoulder two views The acute fracture involving the humeral neck again noted. The humeral head appears to be inferiorly displaced in relation to the glenoid. There is marked soft tissue swelling. | The humeral head appears to be inferiorly displaced likely representing inferior dislocation in relation to the glenoid. |
Generate impression based on findings. | There is mild restricted diffusion involving the left hippocampus, left insular cortex, and pulvinar of the left thalamus, most compatible with postictal change. There is mildly increased FLAIR hyperintensity in the left hippocampus. There is minimal fullness involving the left amygdala. No discrete mass or evidence of mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. CERVICAL SPINE | 1. Persistent abnormal enhancing thoracic cord lesion from T10 to T12 compared to outside MRI from 10/2014. Surrounding T2 hyperintensity compatible with edema is seen from T8 to the T12-L1 level and is improved in the interval. There is small component of enhancement which appears extramedullary and may possibly represent an abnormal vessel (axial post gad 12/64). Overall, differentials include a vascular etiology (infarct with arteriovenous shunt), chronic granulomatous/inflammatory process, as well as neoplasm (given persistence of enhancement and mild mass effect) 2. No new cord lesions.3. Imaging of the brain demonstrates mildly reduced diffusion involving the left hippocampus, left pulvinar, and insula which is most consistent with a most postictal etiology. MRI of the brain is essentially otherwise within normal limits for age. |
Generate impression based on findings. | Male 62 years old Reason: pt with known pancreatic cancer. please eval for progression History: pancreatic cancer CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left lower lobe, best seen on image number 51, series number 5, new from previous study, nonspecific.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Metallic biliary stent is in place.SPLEEN: No significant abnormality notedPANCREAS: Patient's known pancreatic cancer in the head of the pancreas cannot be well separated from the surrounding hazy soft tissue density but appears to be slightly increased in size and now measures 2.2 by 1.8 cm on image number 105, series number 3. Ill-defined soft tissue density now encases the hepatic hilum.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slight interval increase in the size of the patient's known pancreatic head mass with now new encasement of hepatic artery |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal cousin and maternal aunt. Two standard digital views of both breasts with additional bilateral MLO were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is an asymmetry in the left lateral breast, mid depth. Additional bilateral circumscribed asymmetries are stable in size and morphology. No suspicious microcalcifications or areas of architectural distortion are present. | New asymmetry in the left lateral breast seen on the CC view. Additional imaging, including spot compression views and possible ultrasound, are recommended for further evaluation.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Pain. Fracture follow-up. Again seen is a comminuted fracture of the proximal humerus with slight anteromedial displacement and posterolateral angulation of the distal fracture fragment. The fracture plane through the surgical neck of the humerus remains visible, although slightly less distinct on the current study than on the prior study suggesting some interval healing. The greater tuberosity fracture plane is indistinct, suggesting healing. | Proximal humerus fracture as described above. |
Generate impression based on findings. | Male 77 years old Reason: restaging widely metastatic PC and RCC History: restaging widely metastatic PC and RCC CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Complex cystic left upper pole renal mass measures 7.6 by 7.3 cm on image number 106, series number 3. This lesion is slightly increased compared to previous study and suspicious for a cystic renal neoplasm. Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Index enlarge node anterior to the right renal vein measures 1.4 by 0.8 cm in image number 108, series number 3, smaller compared to previous study. Index left paraortic lymph node measures 1.7 by 1.3-cm on image number 135, series number 3, smaller compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive bone metastases throughout the skeleton, again noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index right obturator lymph node measures 1.5 x 0.9 cm in image number 169, series number 3. This node and other pelvic lymph nodes have decreased in size compared to previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive bone metastases are again noted.OTHER: No significant abnormality noted | Interval decrease in the size of the metastatic retroperitoneal lymph nodes.Complex left upper pole renal mass, slightly increased to unchanged compared to previous study. |
Generate impression based on findings. | Reason: s/p left ICH. eval for vascular abnormality History: ICH Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.Atherosclerotic calcifications are present along the distal internal carotid arteries.There is no evidence for a CTA spot sign.The anterior communicating artery is identified and is intact. There is fetal origin of the posterior cerebral arteries bilaterally with small P1 segments.The right vertebral artery is larger than the left vertebral artery. The right vertebral artery is dominant supply to the basilar artery. The left vertebral artery predominantly supplies the left posterior inferior cerebellar artery.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 21 x 11-mm axial dimension hyperdense focus in the left postcentral gyrus associated with a halo of hypodensity. Compared to CT of the head earlier and has not changed.Periventricular and subcortical white matter hypodensities of a mild degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There are scleral calcifications present adjacent to the insertion sites of the ciliary bodies most likely representing scleral plaque. | 1.No evidence for aneurysm.2.No evidence for cerebral vascular occlusive disease3.A left postcentral gyrus hemorrhage is stable compared to the prior exam.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Shoulder dislocation? Glenohumeral joint alignment is normal. Acromioclavicular joint alignment is normal. I see no fracture. | Normal-appearing shoulder without malalignment. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of benign breast biopsy. Family history of breast cancer in cousin. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Status post ALIF July 2014. Fusion status. Again seen is a spacer device at L4/5 containing bone graft material that appears similar to that seen on the prior study. I see no frank interbody fusion at this time. Mild degenerative disk disease affects L5/S1. Vertebral body heights are preserved. Alignment is within normal limits. | Postoperative changes of ALIF as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in paternal grandmother and aunt. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandul`ar density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
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